Five Indonesians die of bird flu

Five more people have died from bird flu in Indonesia , the World Health Organization has confirmed.

The deaths of the five brings Indonesia 's bird flu death toll to 30.

Four of the people who died lived in northern Sumatra and were from the same family. The WHO has sent a team to the area to investigate.

An Indonesian health ministry official told Reuters news agency there was no evidence of human-to-human transmission in the latest cases of the H5N1 virus.

In the cluster of cases in northern Sumatra , up to eight members of a family in Kubu Simbelang village, about 50km (30 miles) south of Medan , could be involved.

Tests are still being carried out to see whether sick relatives also have bird flu.

Scientists are investigating the cause of the outbreak.

"The spread was through risk factors from poultry or other animals. There is no proof of human-to-human," a health ministry official, Nyoman Kandun, told Reuters.

But the agency also quoted an Indonesian agriculture official who said that possibility could still not be ruled out.

"There is a big question mark. Blood samples from all kinds of animals from chickens, ducks, geese, birds, pigs, cats and dogs turned out negative so far. Manure has also been checked. The result is negative," he said.

The outbreak is worrying for officials because it occurred on the island of Sumatra , whereas most cases so far have been recorded in Java.

Worst death rate

The fifth death confirmed on Wednesday occurred in Surabaya in Java. The victim was a 38-year-old caterer whose job involved dealing with livestock and meat. She died last week.

The latest deaths mean 30 people have died from the disease in Indonesia this year - by far the highest death rate in the world in 2006.

Indonesia is second only to Vietnam in the list of countries with most bird flu deaths overall.

However, while Vietnam and third-placed Thailand have managed to slow the spread of the disease and the death toll through tough controls, Indonesia has been criticised for a tardy response.

A senior official at the UN's Food and Agricultural Organization said earlier this week that Indonesia 's government had failed to co-ordinate its reaction and raise public awareness.

Direct contact

The H5N1 virus has killed 115 people worldwide since 2003. It has also devastated poultry stocks.

The majority of deaths have occurred in Asia , but cases in people and birds have also been recorded in Europe and Africa .

Almost all human infections so far are thought to have been caused by direct contact with sick poultry.

Experts fear the virus could mutate into a form that passes easily between humans, possibly sparking a pandemic.

Global impact of bird flu

Much of the world is now on alert for outbreaks of the lethal strain of bird flu that is fast becoming a major avian killer around the world.

Millions of birds have died or been destroyed as a result of outbreaks in dozens of countries since the H5N1 strain emerged in South-East Asia in 2003, before spreading to Europe and Africa.

The number of cases among humans is also rising, and the death toll passed 100 in mid-March 2006, with a mortality rate of just over 50%.

The first human deaths from H5N1 outside Asia , in January 2006, heightened concern about the spread of the disease, but the World Health Organization pointed out that the deaths, in Turkey , were among people who had been in close contact with infected birds, and were not passed from human to human.

Although the WHO says that this is true of most human cases, governments around the world are being encouraged to develop a global policy to try to stem the advance of the virus.

The killer virus has now hit three continents - reaching Nigeria in February 2006 and making major inroads into Europe in the same month.

The main fear is that with each new human case, the chances increase of a mutation that might create a more virulent strain that could pass from human to human.

EUROPE

The first outbreaks in the European Union were recorded in January 2006 when cases were confirmed in wild swans in Italy , Greece , Germany and Austria .

Within weeks, cases were confirmed in Slovenia , Slovakia , Hungary , and France , where mass vaccination of ducks and geese on farms was carried out.

At the end of February, the first case involving a cat in Europe was discovered on the German island where a number of wild birds died from the disease earlier in the month.

And in mid-March, human deaths were confirmed in Azerbaijan , where what is believed to be the first canine case was also diagnosed, in a stray dog.

The first case in the UK was confirmed on 6 April, in a swan found dead on the eastern coast of Scotland .

Click to return

Q&A: Bird flu

What is bird flu?

Like humans and other species, birds are susceptible to flu.

There are 15 types of bird, or avian, flu.

The most contagious strains, which are usually fatal in birds, are H5 and H7.

There are nine different types of H5. The nine all take different forms - some are highly pathogenic, while some are pretty harmless.

The type currently causing concern is the deadly strain H5N1, which can prove fatal to humans.

Migratory wildfowl, notably wild ducks, are natural carriers of the viruses, but are unlikely to actually develop an infection.

The risk is that they pass it on to domestic birds, who are much more susceptible to the virus.

How do humans catch bird flu?

Bird flu was thought only to infect birds until the first human cases were seen in Hong Kong in 1997.

Humans catch the disease through close contact with live infected birds.

Birds excrete the virus in their faeces, which dry and become pulverised, and are then inhaled.

Symptoms are similar to other types of flu - fever, malaise, sore throats and coughs. People can also develop conjunctivitis.

Researchers are now concerned because scientists studying a case in Vietnam found the virus can affect all parts of the body, not just the lungs.

This could mean that many illnesses, and even deaths, thought to have been caused by something else, may have been due to the bird flu virus.

Is it possible to stop bird flu coming into a country?

Because it is carried by birds, there is no way of preventing its spread.

But that does not mean it will be passed to domestic flocks. Experts say proper poultry controls - such as preventing wild birds getting in to poultry houses - which are present in the UK , should prevent that happening.

In addition, they say monitoring of the migratory patterns of wild birds should provide early alerts of the arrival of infected flocks - meaning they could be targeted on arrival.

How many people have been affected?

As of 27 April 2006 , the World Health Organization (WHO) had confirmed 204 cases of H5N1 in humans in Azerbaijan , Cambodia , China , Egypt , Indonesia , Iraq , Thailand , Turkey and Vietnam , leading to 113 deaths.

For the latest WHO information on the numbers of humans infected and killed by avian flu, see related internet links section on right of page.

How quickly is the disease spreading?

After bird flu claimed its first human victim - a three-year-old boy in Hong Kong in May 1997 - the disease was not detected again until February 2003, when a father and son were diagnosed with H5N1, again in Hong Kong .

Since then it has spread westwards through Asia , the Middle East , Europe and Africa .

Despite mass culls, exclusion zones and other measures put in place to prevent its spread, the H5N1 virus has continued to travel.

In one week in February 2006, Italy , Greece , Bulgaria , Germany , Austria , France , Slovenia , India , Iran and Egypt confirmed their first cases of H5N1 in wild birds.

In April 2005, a dead swan in Scotland was found to have the strain.

But it can't yet be passed from person to person?

For the most part, humans have contracted the virus following very close contact with sick birds.

There may have been examples of human-to-human transmission, but so far not in the form which could fuel a pandemic.

A case in Thailand indicated the probable transmission of the virus from a girl who had the disease to her mother, who also died.

The girl's aunt, who was also infected, survived the virus.

UK virology expert Professor John Oxford said these cases indicated the basic virus could be passed between humans, and predicted similar small clusters of cases would be seen again.

It is not the only instance where it has been thought bird flu has been passed between humans.

In 2004, two sisters died in Vietnam after possibly contracting bird flu from their brother who had died from an unidentified respiratory illness.

In a similar case in Hong Kong in 1997, a doctor possibly caught the disease from a patient with the H5N1 virus - but it was never conclusively proved.

What would the consequences of a mass outbreak be?

Once the virus gained the ability to pass easily between humans the results could be catastrophic.

Worldwide, experts predict anything between two million and 50 million deaths.

However the mortality rate - which presently stands at around 50% of confirmed cases - could decline as it mutates, they say.

Is there a vaccine?

There is not yet a definitive vaccine, but prototypes which offer protection against the H5N1 strain are being produced.

But antiviral drugs, such as Tamiflu which are already available and being stockpiled by countries such as the UK , may help limit symptoms and reduce the chances the disease will spread.

Concerns have been prompted by news that patients in Vietnam have become partially resistant to the Tamiflu, the drug that doctors plan to use to tackle a human bird flu outbreak.

Scientists say it may be helpful to have stocks of other drugs from the same family such as Relenza (zanamivir).

Can I continue to eat chicken?

Yes. Experts say avian flu is not a food-borne virus, so eating chicken is safe.

The only people thought to be at risk are those involved in the slaughter and preparation of meat that may be infected.

However, the Who recommends, to be absolutely safe all meat should be cooked to a temperature of at least 70C. Eggs should also be thoroughly cooked.

Professor Hugh Pennington of Aberdeen University underlined the negligible risk to consumers: "The virus is carried in the chicken's gut.

"A person would have to dry out the chicken meat and would have to sniff the carcass to be at any risk. But even then, it would be very hard to become infected."

What is being done to contain the virus in the countries affected?

Steps have been taken to try to stop the disease spreading among birds.

Millions of farmyard birds have been culled, while millions more have been vaccinated and confined indoors.

Areas where the disease has been found have been isolated and some countries have banned imports of live birds and poultry products.

In January 2006 international donors pledged $1.9bn (£1.1bn) in the fight against bird flu, while the World Health Organization has devised a rapid-response plan to detect and contain a global flu pandemic.

There are also measures recommended when a wild infected bird is found, including protection and surveillance zones.

Bird flu lessons from Vietnam

It seems that almost every week, a new case of bird flu is reported somewhere in the world.

But while the disease has only just hit poultry farms in Europe and Africa , Vietnamese farmers like Bui Van Danh are much more familiar with the deadly H5N1 virus.

"At the beginning, I didn't know much about bird flu," said Mr Danh, standing next to his row of chicken sheds in the Mekong delta, southern Vietnam .

"But in the past few years I've learnt a lot," he said, "and now I watch the news to see where else it's spread."

Vietnam has the dubious accolade of being the country worst affected by bird flu, with 42 human deaths since 2003.

A new case of H5 in poultry smuggled from China is now being investigated to see if it is the H5N1 strain.

But apart from this - and after three separate outbreaks in as many years - the country has been disease-free since December, and praised internationally for its quick and comprehensive response.

So how did farmers like Mr Danh manage to get rid of bird flu - and can poultry producers in Europe , with their huge bird farms and modern methods, learn anything from Vietnam 's experience?

Political priority

Dr Hans Troedsson, a World Health Organisation representative in Hanoi , believes that one key lesson is the importance of high-level government commitment.

"You should always start with widespread culling," he said. "Rapid action to cull poultry was taken in Vietnam , and that was because of decisions at prime ministerial level."

Dr Troedsson also emphasised the importance of educating local people, something which Vietnam was initially slow at doing, but has now taken fully onboard.

During the first outbreak, at the end of 2003, Mr Danh was ordered to destroy his seemingly healthy chickens because he was living in an affected area.

"I had 11,000 chickens, and I had to burn all of them," he said bleakly. "I was given compensation but I still felt very sad - and I also felt angry as I didn't really understand why I had to do it."

But since then, the authorities have organised a nationwide education programme, with information broadcast on national media and billboards around the country.

Local meetings were organised, where doctors and agricultural experts explained about the disease.

"It's important that people know to seek help at an early stage of the illness," said Dr Troedsson. "In the first year of the outbreak there was a high mortality rate in Vietnam , but it got better as people became more educated."

Nguyen Trung, head of Ho Chi Minh City 's agriculture department, said it was also important to encourage farmers to change certain practices.

"The best two measures farmers can do are cover their chickens inside a special building, and bury chicken waste so it doesn't get into the river system," he said.

Backyard farming

While Europe can undoubtedly learn from Vietnam 's experiences, there are also many differences between Asian and European methods of raising poultry that make direct comparisons misleading.

About a third of Vietnamese households keep chickens or ducks, many in their backyards, while poultry production in Europe is almost exclusively confined to large-scale farms.

This means that many more Vietnamese come into regular contact with birds, increasing the chance of the disease spreading to humans.

"Ideally we are encouraging people not to raise chickens in their backyards. But for those who do, we are asking them to keep their birds separate from where the family lives," said Dr Truong Giang, deputy director of the health department in Ho Chi Minh City .

The fact that chickens are on virtually every street corner in many parts of rural Asia also has another consequence - it makes containing bird flu much harder.

In the large, relatively isolated, bird flu farms of Europe , it may well be possible to terminate an outbreak by simply culling that one flock.

But in Asia , the situation is far more complicated. During Vietnam 's third outbreak in 2005, the authorities realised that the virus was spreading too quickly to be stamped out by selective culling alone, so a nationwide vaccination programme was introduced as well.

Migratory birds

There is much that scientists have yet to learn about bird flu, and one of the key mysteries involves the significance of wild birds in spreading the disease to domestic poultry.

Most of the outbreaks in Europe have involved migratory birds on flight paths from other affected countries.

It is virtually impossible to monitor this exchange in Asia , where wild birds and domestic birds often mingle freely.

Such monitoring can only really be done in Europe , where it is easier to isolate domestic poultry.

Maybe the best piece of advice Vietnamese farmers can give is that, with prompt, decisive action, it is possible to survive a dreaded outbreak.

"The first time it came to this area, I was very scared," said Mr Danh. "But I culled my birds, because my life is more important than money.

"I thought that, if I survived, I could always build up the farm again," he said.

And Mr Danh has done exactly that. He now has 7,000 birds and is looking forward to the future for the first time in years.